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MacNamara’s Fallacy

December 7, 2007 by bobleckridge

I just came across something called the MacNamara Fallacy – as best I can see it was first described by Charles Handy in his book, The Empty Raincoat (haven’t read it yet but just ordered a second hand copy through Amazon marketplace for a penny!) – Robert MacNamara was US Secretary of Defence during the Vietnam War.

One of the worst characteristics of the current approach to health (an approach shared in other spheres like education, management and so on) is the tendency to measure what can be easily measured and then base every decision on that, disregarding as unimportant whatever cannot be easily measured.

Here’s the quote (this time referred to by Dr David Haslam in the RCGP journal –

Haslam D (2007). British Journal of General Practice 57:545, 987-993.)

  • The first step is to measure whatever can be easily measured. This is OK as far as it goes.

  • The second step is to disregard that which can’t be easily measured, or to give it an arbitrary quantitative value. This is artificial and misleading.

  • The third step is to presume that what can’t be measured easily isn’t important. This is blindness.

  • The fourth step is to say that what can’t be easily measured doesn’t exist. This is suicide.

Posted in from the consulting room, health | 5 Comments »

Hospitals can be dangerous places

December 7, 2007 by bobleckridge

I guess most people would agree with my attitude that if you can manage to avoid hospitals you should. Yes, they are necessary, but, yes, they are dangerous too. How dangerous? Well, a study from the University of York has taken the approach of reading through the records of a thousand patients admitted to one hospital and found almost one in ten of those admitted suffered from an adverse event. They reckon about 30 to 50% of these could have been avoided.

“Our research does confirm though that hospitals are not completely safe places, and that people should try to steer clear of them unless absolutely necessary.”

A Department of Health spokesperson said

“As the study suggests, many adverse events could be avoided if lessons were properly learned and fed back into practice.”

That’s the challenge and that’s part of the answer. Medicine is a person-intensive activity. We should be investing in the training and practice of everyone who works in hospitals. Not just the clinicians. The people who work in hospitals all have important jobs to do and if they don’t do them to the best of their ability all the time, patients suffer. We need to foster a culture of reflection and learning, of continual improvement, not of blame. It’s not about targets. It’s about people.

Posted in from the consulting room, health | 2 Comments »

Community

December 6, 2007 by bobleckridge

old town Nice, originally uploaded by bobsee.

This is a photo taken looking up from a junction in the old town of Nice. The old town has very narrow streets and very tall buildings. It struck me that photos of cities built in recent years aren’t so different from this and a line or two of T S Eliot popped into my head – from his Choruses from The Rock

When the Stranger says: “What is the meaning of this city ?
Do you huddle close together because you love each other?”
What will you answer? “We all dwell together
To make money from each other”? or “This is a community”?

Metropolitan Plaza Ikebukuro Tokyo

(……looking up in Ikebukuro, Tokyo)

Posted in from the dark room, life, photography | Leave a Comment »

Happiness or meaning…..you have to choose?

December 5, 2007 by bobleckridge

Catching up on some episodes of Heroes last night, and was watching Chapter 18, “Parasite”. This is the one where Nathan confronts Lindeman and Lindeman says to Nathan that he has to choose between a life of happiness and a life of meaning. He explains that to live a happy life you have to live in the present, but to have a life of meaning you have to focus on both the past and the future.

Well, I don’t know about you, but that analysis doesn’t work for me. Happiness, as Jean Kazez explains in her review of three interesting books about the subject, has not only been studied by a wide range of thinkers over the years, but there are a huge number of different opinions about it. Certainly the view that happiness is experienced by being “present” is one of them, but surely happiness can be experienced in reminiscence and recall, and certainly in sweet dreams and fantasies.

Jonathon Haidt, for one is quite clear that happiness is part of the experience of the creation of a meaningful life, and I agree with that. Happiness, meaning, mutually exclusive options? I don’t think so.

Lindeman’s point about a life of meaning spreading out beyond the present was a good one though. I really do think the way we create a sense of self is through the narratives we create about our lives. And all narratives are dynamic, they come from somewhere, to inform what is, and set the trajectories of what might lie ahead. One of my favourite books on the power of narrative in life is “On Stories” by Irish philosopher, Richard Kearney. He says –

When someone asks you who you are, you tell your story. That is, you recount your present condition in the light of past memories and future anticipations

and

Telling stories as basic to human beings as eating. More so, in fact, for while food makes us live, stories are what make our lives worth living

In fact, he makes it clear that as meaning-seeking and meaning-creating animals we use story telling to not only make sense of our life experiences but to make life itself meaningful.

So, Lindeman was right about a life of meaning involving an ability to sew together the past, the present and the future, and I suspect it was this, most seductive of options that helped Nathan make his choice.

Like all heroes, we become who we are by the stories we fashion out of our unique and individual ways of experiencing life.

Posted in from the viewing room, life | 5 Comments »

Walking in step

December 5, 2007 by bobleckridge

in step, originally uploaded by bobsee.

It is important for each of us to be aware of our uniqueness and to celebrate our differences. We need that to develop a strong secure sense of self and we need it even at the level of our immune system which rigorously defends us against everything that is not us.
But we also need to connect, to build relationships and to share experiences with others. We can do that in many ways, and lots of those ways are quite subconscious. I wonder if these two young women went to the shoe shop together and bought these shoes? I wonder if they chose to wear them explicitly to make a connection with each other. They are different enough in the rest of their dress style after all.
But what really struck me in this shot was how in step they were. They’re not just wearing red shoes of similar (but not same) style, but they are walking perfectly in step. Almost like dancers.
You’ll be familiar with mirroring. It’s something I see in consultations frequently. When two people are connected, their unconscious gestures, (scratching their nose, touching their ear, body position etc) often mirror each other. There’s even a neurological theory about mirroring neurones which are networks in the brain which fire off movement patterns which would mimic another person’s movements.
Whatever the explanation, these connections are the basis of empathy – the ability, sometimes literally! to put yourself in another person’s shoes!

Posted in from the dark room, from the living room, life, photography | 1 Comment »

Three elements

December 3, 2007 by bobleckridge

pebbles and foam, originally uploaded by bobsee.

As the waves broke on the stony beach they turned pure white rattled the pebbles against each other smoothing and shining them and as the foam seeped into the earth or back out into the sea it made a lovely fizzing bubbling noise. It only lasted a few seconds, then it’d be gone, washed away by the surge of the sea, the crash of the waves and noisy rattling of the stones again. It’s an incredibly soothing, calming cycle, breathing in and out in time with the surf.
Here’s the moment where air, water and stone come together to create a very distinct sound, sight and texture.
Can you hear it?
Can you feel it?

Posted in from the dark room, photography | 3 Comments »

The middle of……..

December 2, 2007 by bobleckridge

hub, originally uploaded by bobsee.

Do you know what this is the middle of?

Posted in from the dark room, photography | 5 Comments »

Christmas decorations in Nice, France

December 2, 2007 by bobleckridge

Nice has some really interesting and different illuminations up at the moment. There are a number of larger than life size sculptures of men sitting atop high poles. They change colour constantly

the future is orange

in the pink

and, here’s one of them in the daylight

white man

Posted in from the dark room, photography | 1 Comment »

Things look different at night

December 2, 2007 by bobleckridge

night fisher, originally uploaded by bobsee.

I took this photo on the beach at Nice last night, using the night scene function on my camera.
I like how it’s turned out. It was very dark, and I could only just make out this fisherman in front of the surf.
I love the hues of green in this photo and I really like the way the surf softens under the longer exposure time conveying the constant movement of the water.

Posted in from the dark room, photography | Leave a Comment »

Vonnegut on creativity and purpose

November 30, 2007 by bobleckridge

There’s a great post across in four hour week – a precis of Kurt Vonnegut’s last interview – it’s worth a read in full but these two answers really grabbed me –

Tell me the reasons you’ve been attracted to a life of creation, whether as a writer or an artist.

I’ve been drawing all my life, just as a hobby, without really having shows or anything. It’s just an agreeable thing to do, and I recommend it to everybody. I always say to people, practice an art, no matter how well or badly [you do it], because then you have the experience of becoming, and it makes your soul grow. That includes singing, dancing, writing, drawing, playing a musical instrument. One thing I hate about school committees today is that they cut arts programs out of the curriculum because they say the arts aren’t a way to make a living. Well, there are lots of things worth doing that are no way to make a living. [Laughs.] They are agreeable ways to make a more agreeable life.

In the process of your becoming, you’ve given the world much warmth and humor. That matters, doesn’t it?

I asked my son Mark what he thought life was all about, and he said, “We are here to help each other get through this thing, whatever it is.” I think that says it best. You can do that as a comedian, a writer, a painter, a musician. He’s a pediatrician. There are all kinds of ways we can help each other get through today. There are some things that help. Musicians really do it for me. I wish I were one, because they help a lot. They help us get through a couple hours.

I agree with these sentiments so much –  we should all practice something creative – it makes our souls grow. And we are here to help each other get through this thing – a life spent without this motivation is a life lacking something in my opinion.

Posted in from the reading room | 2 Comments »

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